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General NPI Number Information
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NPI Number | 1831616291
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Entity Type | Individual
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Provider Name | LAYCI J HARRISON LAT ATC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2017
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 3875 HOLMAN ST RM 104
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City | HOUSTON
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State | TX
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Zip | 77204-6606
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Country | US
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Telephone | 713-743-9875
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Fax |
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Provider Business Mailing Address
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Address Line | 15122 CRANBOURNE DR
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City | HOUSTON
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State | TX
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Zip | 77062-2622
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Country | US
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Telephone | 703-598-9191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0000001708
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7550
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License Number State | TX
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